Mr. Christian Jaggy:

I can provide an international view from Switzerland but clearly all the experts at this table will find the solution for Ireland. With regard to the problem Mr. Clancy mentioned, in Switzerland consultants can use operating theatres in hospitals. They then receive a lump sum payment and half of this must be paid to the hospital which provided the facility. What happens in Switzerland could be used to provide the type of incentives to which Mr. Clancy referred. From what I have heard at this meeting, it seems that in Ireland there is a cultural achievement of private medical insurance. That is something which the population of Ireland wants. Price increases have been triggered by certain stakeholders in the market here and this has had consequences for health insurers.

They need to increase the price, thereby destroying their currently healthy age structure. One is really in a fragile set of circumstances if one imposes additional charges by means of the levy approach or by way of the public hospital bed. That is just the short-term view.

With regard to the mid-term view, one should consider having a core set of benefits allowing for risk equalisation. That is in place in Switzerland. There could also be additional cover, perhaps based more on private insurance. This has also been implemented in Switzerland, leading every year to a price increase of 4% to 7%. One does not achieve the perfect position with that system either but one has a certain control.

The members know all the answers to the questions I have heard but I do not know whether they have the data required for analysis. Information is supplied by the hospitals to the insurers on a manual basis. Therefore, one does not get the codes of diagnosis or the treatment. Therefore, how can one have a benchmark to know which hospital is providing the service in the most cost-effective way? If this information is not obtained, one should implement control measures in order to measure who is providing the service in the best way, thereby putting economic incentives in place. That is my perspective on what I observe internationally. Those present know all the answers at the table and that is why I would also wish to have the insurers in consultation.